Editing Bone marrow suppression

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| synonym         = Myelotoxicity, myelosuppression
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'''Bone marrow suppression''' also known as '''myelotoxicity''' or '''myelosuppression''', is the decrease in production of cells responsible for providing immunity ([[leukocytes]]), carrying oxygen ([[erythrocytes]]), and/or those responsible for normal blood clotting ([[thrombocytes]]).<ref>{{cite web
|url=http://medical-dictionary.thefreedictionary.com/bone+marrow+suppression|title=bone marrow suppression|access-date=3 May 2011}}</ref> [[Bone marrow]] suppression is a serious [[side effect]] of [[chemotherapy]] and certain drugs affecting the [[immune system]] such as [[azathioprine]].<ref>[http://www.marvistavet.com/html/body_azathioprine.html Azathioprine side effects] {{webarchive |url=https://web.archive.org/web/20101125155614/http://www.marvistavet.com/html/body_azathioprine.html|date=November 25, 2010}}</ref> The risk is especially high in cytotoxic chemotherapy for [[leukemia]]. In the case of [[non-small-cell lung cancer]], myelosuppression predisposition was shown to be modulated by [[Enhancer (genetics)|enhancer]] mutations.<ref>{{Cite journal |last1=Zhigulev |first1=Artemy |last2=Norberg |first2=Zandra |last3=Cordier |first3=Julie |last4=Spalinskas |first4=Rapolas |last5=Bassereh |first5=Hassan |last6=Björn |first6=Niclas |last7=Pradhananga |first7=Sailendra |last8=Gréen |first8=Henrik |last9=Sahlén |first9=Pelin |date=March 2024 |title=Enhancer mutations modulate the severity of chemotherapy-induced myelosuppression |journal=Life Science Alliance |volume=7 |issue=3 |pages=e202302244 |doi=10.26508/lsa.202302244 |issn=2575-1077 |pmc=10796589 |pmid=38228368}}</ref>

[[Nonsteroidal anti-inflammatory drug]]s (NSAIDs), in some rare instances, may also cause bone marrow suppression. The decrease in blood cell counts does not occur right at the start of chemotherapy because the drugs do not destroy the cells already in the bloodstream (these are not dividing rapidly). Instead, the drugs affect new blood cells that are being made by the bone marrow.<ref>[http://www.cancer.org/Treatment/TreatmentsandSideEffects/TreatmentTypes/Chemotherapy/ChemotherapyPrinciplesAnIn-depthDiscussionoftheTechniquesanditsRoleinTreatment/chemotherapy-principles-chemo-side-effects-bone-marrow-suppression Bone marrow suppression]</ref> When myelosuppression is severe, it is called myeloablation.<ref>[http://www.cancer.gov/dictionary/?CdrID=44173 Dictionary of Cancer Terms: myelosuppression ]</ref>

Many other drugs including common antibiotics may cause bone marrow suppression. Unlike chemotherapy the effects may not be due to direct destruction of stem cells but the results may be equally serious. The treatment may mirror that of chemotherapy-induced myelosuppression or may be to change to an alternate drug or to temporarily suspend treatment.

Because the bone marrow is the manufacturing center of blood cells, the suppression of bone marrow activity causes a deficiency of blood cells. This condition can rapidly lead to life-threatening [[infection]], as the body cannot produce [[leukocytes]] in response to invading [[bacteria]] and [[viruses]], as well as leading to [[anaemia]] due to a lack of [[red blood cells]] and spontaneous severe bleeding due to deficiency of [[platelets]].

[[Parvovirus B19]] inhibits [[erythropoiesis]] by lytically infecting RBC precursors in the bone marrow and is associated with a number of different diseases ranging from benign to severe. In [[immunocompromised]] patients, B19 infection may persist for months, leading to chronic [[anemia]] with B19 viremia due to chronic marrow suppression.<ref>[http://www.wrongdiagnosis.com/h/human_parvovirus_b19_infection/book-diseases-20a.htm Parvovirus B19 - BASICS]</ref>

==Treatment==
Bone marrow suppression due to [[azathioprine]] can be treated by changing to another medication such as [[mycophenolate mofetil]] (for organ transplants) or other disease-modifying drugs in [[rheumatoid arthritis]] or [[Crohn's disease]].

===Chemotherapy induced myelosuppression===
Bone marrow suppression due to anti-cancer chemotherapy is much harder to treat and often involves hospital admission, strict infection control, and aggressive use of intravenous [[antibiotics]] at the first sign of infection.<ref>{{Cite journal
|last1=Al Sudairy|first1=Reem
|last2=Alzahrani|first2=Mohsen
|last3=Alkaiyat|first3=Mohammad
|last4=Alshami|first4=Mona
|last5=Yaqub|first5=Abdullah
|last6=Al Fayadh|first6=Maha
|last7=Al-Surimi|first7=Khaled
|last8=Jazieh|first8=Abdul Rahman
|date=2019-08-01
|title=Improving Door-to-Antibiotic Administration Time in Patients With Fever and Suspected Chemotherapy-Induced Neutropenia: A Tertiary Care Center Experience
|url=https://meridian.allenpress.com/innovationsjournals-JQSH/article/2/3/78/434843/Improving-Door-to-Antibiotic-Administration-Time
|journal=Global Journal on Quality and Safety in Healthcare|language=en|volume=2|issue=3|pages=78–84|doi=10.4103/JQSH.JQSH_1_19
|s2cid=181784553
|issn=2666-2353|doi-access=free}}</ref>

[[G-CSF]] is used clinically (see [[Neutropenia]]) but tests in mice suggest it may lead to bone loss.<ref name=Dec2006>[http://news.wustl.edu/news/Pages/8512.aspx "Researchers urge monitoring of bone health during chemotherapy"].</ref><ref name="pmid17192391">{{Cite journal
|vauthors=Hirbe AC, Uluçkan O, Morgan EA, Eagleton MC, Prior JL, Piwnica-Worms D, Trinkaus K, Apicelli A, Weilbaecher K
|title=Granulocyte colony-stimulating factor enhances bone tumor growth in mice in an osteoclast-dependent manner
|journal=Blood|volume=109|issue=8|pages=3424–31|date=April 2007
|pmid=17192391|pmc=1852257|doi=10.1182/blood-2006-09-048686}}</ref>

[[GM-CSF]] has been compared to G-CSF as a treatment of chemotherapy-induced myelosuppression/[[Neutropenia]].<ref name="pmid9679526">{{Cite journal |author=Beveridge RA
|title=A comparison of efficacy of sargramostim (yeast-derived RhuGM-CSF) and filgrastim (bacteria-derived RhuG-CSF) in the therapeutic setting of chemotherapy-induced myelosuppression
|journal=Cancer Invest.|volume=16|issue=6|pages=366–373|year=1998
|pmid=9679526|doi=10.3109/07357909809115775
|author2=Miller JA
|author3=Kales AN
|last4=Binder|first4=Richard A.
|last5=Robert|first5=Nicholas J.
|last6=Harvey|first6=Jimmie H.
|last7=Windsor|first7=Kevin
|last8=Gore|first8=Ira
|last9=Cantrell|first9=James}}</ref>

[[Trilaciclib|Trilaciclib (COSELA)]], a [[CDK inhibitor|CDK4/6 inhibitor]], is administered before [[chemotherapy]] in [[Small-cell carcinoma|small cell lung cancer]] to control chemotherapy-induced myelosuppression. <ref>{{Cite web|last=Commissioner|first=Office of the|date=2021-02-12|title=FDA Approves Drug to Reduce Bone Marrow Suppression Caused by Chemotherapy|url=https://www.fda.gov/news-events/press-announcements/fda-approves-drug-reduce-bone-marrow-suppression-caused-chemotherapy|archive-url=https://web.archive.org/web/20210212221033/https://www.fda.gov/news-events/press-announcements/fda-approves-drug-reduce-bone-marrow-suppression-caused-chemotherapy|url-status=dead|archive-date=February 12, 2021|access-date=2021-11-04|website=FDA|language=en}}</ref>

==Research==
In developing new chemotherapeutics, the efficacy of the drug against the disease is often balanced against the likely level of myelotoxicity the drug will cause. In-vitro colony forming cell (CFC) assays using normal human bone marrow grown in appropriate semi-solid media such as ColonyGEL have been shown to be useful in predicting the level of clinical myelotoxicity a certain compound might cause if administered to humans.<ref>[http://www.genengnews.com/gen-articles/predicting-drug-induced-myelotoxicity/3190/ predicting-drug-induced-myelotoxicity]</ref> These predictive in-vitro assays reveal effects the administered compounds have on the bone marrow progenitor cells that produce the various mature cells in the blood and can be used to test the effects of single drugs or the effects of drugs administered in combination with others.

==See also==
* [[Hematopoietic stem cell transplantation]]
* [[Neutropenia]], low leukocytes

== References ==
{{Reflist}}

{{DEFAULTSORT:Bone Marrow Suppression}}
[[Category:Hematology]]
[[Category:Oncology]]